How to prevent contracting malaria during your next holiday

Posted on 1 December 2017

Travelling to high-risk malaria areas in Limpopo, Mpumalanga and areas of Kwazulu-Natal for your holiday this year? Mediclinic malaria expert Dr Stefan Basson explains why taking malaria medication and employing other personal preventative measures is a non-negotiable.

Have you mistakenly been led to believe that antimalarial drugs – or prophylaxis – will mask or suppress the symptoms of malaria, making it more difficult to diagnose? Or maybe you’ve heard talk that their side effects may ruin your holiday and that taking them means you won’t be able to drink alcohol at all? Possibly you may think they cost too much? All of these are misperceptions! If you don’t take malaria prophylaxis, you could potentially not only ruin your holiday but it may be the most fatal mistake you’ve ever made.

Worldwide, there are 212 million reported malaria cases annually and around 429 000 deaths, according to the World Health Organization. ‘In South Africa, for the 2016/2017 season, there have been 9478 cases reported, which is up from 6375 for the previous year – and 76 deaths,’ warns Dr Stefan Basson, principal clinical manager of the Emergency Centre at Mediclinic Nelspruit in Mpumalanga.

‘It’s crucial that all travellers to malaria areas take antimalarial medication. Malaria is a deadly disease. Prophylaxis helps prevent all kinds of malaria, including cerebral malaria. Cerebral malaria is a rare, but deadly form of malaria and usually develops in patients that are immune compromised or where diagnosis is delayed.’

Malaria is endemic in Limpopo, Mpumalanga and Kwazulu-Natal, and mostly found closer to the border areas with Mozambique and the Kruger National Park he says.

Prophylactic malaria drugs available in SA

Prophylaxis works in various ways, but basically suppresses the establishment of the infection in the liver, explains Dr Basson. ‘The medication is only available via prescription, so it’s absolutely imperative that you see your doctor or visit a travel clinic before travelling to a malaria region,’ he says.

These are your options:

Option 1: Malanil (Atovaquone-proguanil). Start two days before you leave. Continue for seven days after leaving the area. It can be used for children from one year onwards.

Option 2: Doxycycline. Start two days before you leave and continue for four weeks after leaving.

Option 3: Mefloquine. Start two weeks before you leave and continue for four weeks after leaving. Discuss the dose with your doctor.

‘The reason for taking prophylaxis for an extended period after leaving the malaria area is to both suppress infection and to kill the hypnozoites that can cause relapses,’ explains Dr Basson.

Alcohol use while taking this medication is definitely not a contra-indication, says Dr Basson. ‘However, some of the side effects are exacerbated by alcohol and vice versa – that is, the drugs will make a hangover worse. Side effects are usually mild and temporary, and can vary from gastro-intestinal complications, including diarrhoea, cramps and nausea, to headaches and malaise.’

Who shouldn’t take prophylaxis?

Ideally, pregnant women should avoid travelling to malaria areas, as they’re a high-risk group for contracting the disease (pregnancy suppresses your immune system to keep your baby safe), cautions Dr Basson. ‘The drug Chloroquine can be prescribed if necessary. It’s also unfortunately very difficult to treat malaria during pregnancy. Ideally, children younger than five years old should also not travel to malaria areas. However, children from one year old and more than 10kg can take prophylaxis.’

If you’re taking certain chronic medication or have an established drug allergy, you may be unable to take them – consult with your doctor and check the warnings within the medication pamphlet.

Other preventative measures you should take

Unfortunately, although prophylaxis is the most effective weapon against the deadly disease, it isn’t 100 percent effective, cautions Dr Basson. ‘Medication should always be used in conjunction with personal protective measures, particularly when mosquitoes are at their most active between 10pm and 4am. Stay within screened areas, sleep underneath mosquito nets, wear clothes with long sleeves and use mosquito repellant sprays or lotions,’ he advises.

Malaria symptoms and treatment

One of the first symptoms will be fever, so if you develop one after visiting a malaria area, get tested immediately so that treatment is not delayed. Other symptoms may include rigors/chills, fatigue, night sweats, shivering and sweating. The time of onset from exposure (incubation period) is typically nine to 14 days, but could be longer.

Plasmodium Falciparum malaria – the most common type in South Africa – is usually treated with Co-Artem. ‘If it’s severe malaria, or the patient can’t tolerate oral medication, intravenous Artesunate is used for the first 24 hours, after which we continue with Co-Artem,’ says Dr Basson.

Good sites to check before you travel

  1. The South African Travel Health Network: https://www.santhnet.co.za/
  2. The Centers for Disease Control and Prevention (CDC): https://www.cdc.gov
  3. The National Institute for Communicable Diseases (NICD): www.nicd.ac.za

The CDC and NICD have ‘live maps’ of high-risk areas where prophylaxis is recommended.

Published in First Aid

In the interest of our patients, in accordance with SA law and our commitment to expertise, Mediclinic cannot subscribe to the practice of online diagnosis. Please consult a medical professional for specific medical advice. If you have any major concerns, please see your doctor for an assessment. If you have any cause for concern, your GP will be able to direct you to the appropriate specialists.

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